Document Detail


Response of chronic cough to acid-suppressive therapy in patients with gastroesophageal reflux disease.
MedLine Citation:
PMID:  23117307     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Epidemiologic and physiologic studies suggest an association between gastroesophageal reflux disease (GERD) and chronic cough. However, the benefit of antireflux therapy for chronic cough remains unclear, with most relevant trials reporting negative findings. This systematic review aimed to reevaluate the response of chronic cough to antireflux therapy in trials that allowed us to distinguish patients with or without objective evidence of GERD.
METHODS: PubMed and Embase systematic searches identified clinical trials reporting cough response to antireflux therapy. Datasets were derived from trials that used pH-metry to characterize patients with chronic cough.
RESULTS: Nine randomized controlled trials of varied design that treated patients with acid suppression were identified (eight used proton pump inhibitors [PPIs], one used ranitidine). Datasets from two crossover studies showed that PPIs significantly improved cough relative to placebo, albeit only in the arm receiving placebo fi rst. Therapeutic gain in seven datasets was greater in patients with pathologic esophageal acid exposure (range, 12.5%-35.8%) than in those without (range, 0.0%-8.6%), with no overlap between groups.
CONCLUSIONS: A therapeutic benefit for acid-suppressive therapy in patients with chronic cough cannot be dismissed. However, evidence suggests that rigorous patient selection is necessary to identify patient populations likely to be responsive, using physiologically timed cough events during reflux testing, minimal patient exclusion because of presumptive alternative diagnoses, and appropriate power to detect a modest therapeutic gain. Only then can we hope to resolve this vexing clinical management problem.
Authors:
Peter J Kahrilas; Colin W Howden; Nesta Hughes; Michael Molloy-Bland
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  Chest     Volume:  143     ISSN:  1931-3543     ISO Abbreviation:  Chest     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-04-11     Completed Date:  2013-07-08     Revised Date:  2014-03-09    
Medline Journal Info:
Nlm Unique ID:  0231335     Medline TA:  Chest     Country:  United States    
Other Details:
Languages:  eng     Pagination:  605-12     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Chronic Disease
Cough / drug therapy*,  epidemiology*
Gastroesophageal Reflux / drug therapy,  epidemiology*
Histamine H2 Antagonists / therapeutic use
Humans
Patient Selection
Proton Pump Inhibitors / therapeutic use*
Ranitidine / therapeutic use
Treatment Outcome
Grant Support
ID/Acronym/Agency:
R01 DK56033/DK/NIDDK NIH HHS
Chemical
Reg. No./Substance:
0/Histamine H2 Antagonists; 0/Proton Pump Inhibitors; 884KT10YB7/Ranitidine
Comments/Corrections
Comment In:
Chest. 2013 Mar;143(3):587-9   [PMID:  23460143 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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